We have parental permission to publish these details about Dukchung’s loss of hearing and the help that Ear Aid Nepal was able to provide.

Dukchung belongs to a small Tibetan type people group called the Lomi living close to the Tibetan border in North East Nepal. There is also a small community living in Kathmandu.

Fortunately for him we have a close connection through Sandra who is an Austrian Audiologist/Speech and language therapist who was working at the ear Centre in Pokhara and doing research and a Masters degree looking at the data accumulated from past ear camps, and also people’s attitudes to hearing loss. She has married into this group and knows their remote home district in the mountains.

Dukchung is a 7-year-old boy and he had a fever in August/September 2017, with swelling in front of his ears, most likely due to mumps affecting the salivary glands. He then complained about bilateral hearing loss. It is well known that the mumps virus can cause profound nerve deafness. The family was concerned and sent him to TU Teaching Hospital in Kathmandu (Nov. 2017). The hospital tested him thoroughly and confirmed that he had lost almost all hearing in both ears.

Dukchung Lama is from Namase (Sankuwashaba District, North Eastern part of Nepal). He has 4 siblings (2 brothers, 2 sisters) and his parents are farmers in the mountains. His older brother is studying in Kathmandu.

Here is a picture of him at Sandra’s wedding in Kathmandu. Although he participated in the dancing and celebrations, it was clear that he could not hear the music or people’s voices.

And here is his pure tone audiogram showing the bilateral hearing loss:

The Hospital suggested cochlear implants on both ears but the family was not able to pay for the whole treatment. The total cost of an implant (for 1 ear) is 12 Lakh Nepali Rupees (approximately US$ 12,000). The government/hospital will support the family with approximately US$ 4,000 (4 Lakh Nepali Rupees). A local church (Ghangri Church) in Kathmandu is talking about funding them and the family will probably take a loan from friends and family.

The closely knit community pulled together and held a meeting at which they agreed to put a good sum towards his care. However a large loan would still be needed. Interest rates on loans in Nepal can be very high and unaffordable. Sandra asked EAN whether we could help.After extensive enquiries and checking that the parents (who are relatively uneducated village folk) and the community would ensure that he had good long term care, and that they fully understood the implications of cochlear implantation, it was agreed that EAN would contribute a sum of £2,000.

Time was also important because delay could affect the ability to fit an implant and a prolonged period of deafness would affect his long term hearing outcome and brain development for hearing and language.

Dukchung underwent full assessment and surgery was initially planned for the end of February. Finance all had to be agreed and provided up front so that implant could be purchased ahead of the operation.

Sandra later reported:

We’re back from the mountains and finally connected to the internet again.

I just quickly wanted to inform you that Dukchung got his CI implanted on May 21st 2018. Everything went well. We haven’t met him yet but probably will soon. He’s still waiting for initial switch on. TU hospital will call them soon. I will send some pictures and update then ;-) His mum came together with us to KTM, they are so thankful to everyone who was helping and supporting.Greetings from KTM,.

Then subsequently we heard:

He came today and we did some therapy. He’s doing very well, he’s already handling the CI himself, understands a lot and is speaking way more than before. At the moment he’s living with his brother who takes care of him but schooling is a bit tricky. We’re discussing about putting him in a Hostel in Kathmandu and hope we won’t have any issues as he’s having a CI. There are several options and we’re trying to find the best solution.

Here are recent photos, taken shortly after CI switch on - we will keep a close eye on his progress and update the news as we do so.

The 3rd March each year is WHO World Hearing Day. The INF Ear Services Team organised a rally, walking through the streets of Pokhara and finishing with presentations at the Ear Centre. Nearly 200 people marched with placards and banners, to publicise the needs of hard of hearing and deaf people and give educational messages. There were talks about the dangers of loud noise and other preventable causes of hearing loss. Many nursing students attended and it was great to have participation by a large contingent from a local school for deaf children, with their sign language interpreter.

WHO local representative making a speech at World hearing day.

On the march!

Mugs made locally for presentation, health education and as gifts for donors and visitors.

On 16th March there was a half-day training for over 40 nurses from around Pokhara; topics included common ear conditions, their prevention and treatment, and nursing care for those having surgery.

Nurses in the training hall of the INF GPH Ear Centre.

From 18th-29th March a surgeon visited us from Los Angeles. Adam Masters is a senior resident at the well-known House ear clinic. The link was made through our EAN network and a senior colleague in the U.S. The clinic promotes ‘humanitarian’ visits by their residents at the end of their specialist ear training. Adam participated in a number of events. On the 24th March we held a seminar for ENT doctors and audiologists, with 16 participants, including two from Kathmandu. Adam led four talks and we had good audience participation when we discussed a number of ear problem case studies. Then, on the 25th March we visited the home village of one of our Medical Officers and with the excellent assistance of village leaders including the health post in-charge, where, at the youth club, we were able to examine the ears and hearing of 145 people of all ages. Several had significant problems that could benefit from surgery, many more require hearing aids, and plenty had very hard wax blocking their ears and we were able to clear this for them. Medicines were also provided. We made arrangements for those needing help to attend the Ear Centre.

Visiting senior resident from House Ear clinic.

Mike at the community ear care outreach day in the village of Nirmalpokhari, first of many we hope, once ear care workers are trained.

Receiving a certificate of appreciation from local youth club, and health post in-charge.

Ladies line waiting for ear checks outside the school in the village

EAN makes significant contributions to the INF Green Pastures Hospital Charity fund, part of which is specifically allocated for Ear Centre patients. This has been well used in recent months, many patients have had heavily subsidised or free treatment. We will top up the fund as required every few months. All patients are already treated at significantly reduced cost because the buildings, equipment and some supplies have been provided from charitable sources, including EAN. Some patients need extra subsidy and there are staff assigned to assess their individual needs. We are very grateful to donors for this opportunity to assist needy patients. We are seeing more people, travelling from further afield, knowing they will get good care.

In coming weeks we will have a Swiss medical student join us for about four weeks, and a team of four from Warwick University visit for one week.

The Warwick team are developing a research programme, intending to assess the needs and requirements for low cost hearing aids for lower income countries. As part of this there is need to develop a supply and maintenance infrastructure and train local people to test peoples ears and fit the aids. This is a fact-finding initiative and fits well with our own desire to train ear care workers for community work. INF have recently advertised five posts for ear care workers, practitioners and health educators, all of which we will need to train! We have also recently appointed two new nurses and had requests to train other paramedicals such as those working with the Gurkha Welfare Trust for retired army personnel and their families and home villages.

Sandra, our Austrian audiologist recently married Dorje Lama and there was a lovely wedding celebration in Kathmandu. The 10-year-old son of a family in Dorje’s community from far northeast Nepal recently became profoundly deaf due to mumps. He was assessed as very suitable for a cochlear implant in Kathmandu and EAN has made a substantial donation towards this. We will be following his progress with excitement.

Dukchung, the young deaf boy we are supporting for a cochlear implant. He joined in Sandra’swedding dances but clearly could not hear the tune. He still followed the dance steps though!

Over recent months INF have developed a 3-year plan for developing ear services at the Ear Treatment and Training Centre as well as providing outreach community work. Wonderfully, funding was approved by SON our Swiss sister organisation. On 27th March a formal agreement was signed between SON and INF in the presence of the Swiss consul from Kathmandu. Mike Smith gave a talk about the past camps, the present Ear Centre and the future development of services to be offered, based on the Ear Centre at GP Hospital. GPH overall is also undergoing major service developments for prevention and rehabilitation of other disabilities, including the start of a plastic surgery department, and the Ear Centre may play a part in helping to develop facial plastic surgery services.

Neonatal screening EAN trustee Phil Holt and his practice manager Aimee Cooke have been a great help in helping to source and coordinate the purchase of a generously discounted diagnostic audiological system (Otometrics, ABR/OAE/VEMP, for those in the know!). This is needed in order to start a testing programme for babies and young children. We hope to work with the regional hospital to screen new-borns. Statistically we estimate that a baby will be born with profound hearing loss once every 1-2 weeks in that one hospital. Setting up and staffing this project is a major challenge, let alone providing care and treatment for families identified.

Continuing Medical Education We have run one journal club for our ear doctors and audiologists to review medical articles of interest, and led two of the regular GPH morning CME sessions, one about anaesthetic care pre- and post-op and one about facial nerve palsy.

Our chief Nepali ear surgeon recently attended a short conference on endoscopic ear surgery at a hospital near Chitwan and our two audiologists are currently attending the annual conference for audiologists and speech therapists in Kathmandu.

Surgical Laser With help from SON the Ear Centre recently acquired a portable laser (KTP) for use with certain types of surgery, (particularly stapedotomy for otosclerotic deafness). It has taken some months of planning and a member of the company (Marcel Ernstberger of A.R.C.) came from Germany to help us set up and use the system safely. The first patient, who had particular technical issues for which a laser was ideal, has had a good outcome.

Marcel demonstrates the compact laser system.

Endoscopic ear surgery With the purchase of a medical HD video system by SON and the use of a number of Endoscopes and instruments donated or purchased through EAN contacts in the UK we have started endoscopic ear surgery. This technique is gaining importance world wide because it gives a particularly good view and access into the middle ear, and avoids large skin incisions.

Donated microscopes We are using several outpatient and surgical microscopes donated from the UK, particularly from EAN trustee’s ENT department in Worcester. These are in daily use and invaluable. We have video connections (funded by EAN) so that staff can be trained, and patients and families can observe (if they want to!).

Out-patient, ear microscopy room.

EAN Otology Bursary In 2017 EAN organised a very successful bursary for two Nepali ENT surgeons to visit the UK for a course in Dundee and a period of observation in a major London hospital (aided by Trustees Tom and Rosie Martin, and Dr Jeremy Lavy, consultant Otologist). We have offered this bursary again, this time for up to two ENT surgeons and one audiologist, this has been advertised through the Society of Otolaryngologists in Nepal and their contacts. We will shortlist in June.

There is much more to come, but we can save that for the next news item!